SEC Form 4 · accession 0001415889-15-002882
VIVOS INC · RDGL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James C Katzaroff
Officer — CHIEF EXECUTIVE OFFICER · Director
Period of report
Aug 21, 2015
Accepted (ET)
Aug 25, 2015 · 1:31 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001449349
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible Promissory NoteF1 | — | Aug 21, 2015 | P | — | A | Aug 21, 2015 | Dec 31, 2015 | See Note 1 below | — | — | D |
| Convertible Promissory NoteF1 | — | Aug 21, 2015 | C | — | D | Aug 21, 2015 | Dec 31, 2015 | See Note 1 below | — | — | D |
| Series A Convertible Preferred StockF2 | $0.005 | Aug 21, 2015 | C | 3,000 | A | Aug 21, 2015 | — | Common Stock | 3,000,000 | 10,500 | D |
Explanation of responses
- F1The Convertible Promissory Note (the "Note") is convertible into either (i) that number of the Issuer's common stock equal to the outstanding principal amount, plus all accrued and unpaid interest, divided by $0.001 (the "Conversion Shares"), or (ii) one (1) share of the Company's Series A Convertible Preferred Stock ("Series A Preferred") for every one thousand (1,000) Conversion Shares.
- F2The Series A Preferred has no expiration date.